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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

OIG, Fraud and Abuse, OIG Exclusion

Twice the Trouble: Healthcare Fraud Continued After Exclusion

Posted by Michael Rosen, ESQ on Tue, Oct 03, 2017

Double trouble. A dual affair. Twice the trouble that could have been avoided. You get the picture. Here is a case of twin brothers who banded together to commit massive healthcare fraud to fund their lavish lifestyle. Now they are in double trouble.

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OIG, OIG Work Plan, compliance program

September OIG Work Plan Updates

Posted by Michael Rosen, ESQ on Tue, Sep 19, 2017

Each month, we are pleased to share the most recent additions to the Office of Inspector General (OIG) Work Plan items. As of June 2017, OIG updates their Work Plan monthly with any new changes to the active list. Let’s take a look at the new points of emphasis for compliance professionals moving forward.

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OIG, Affordable Care Act, Medicaid

State Medicaid Agencies Still Challenged with Determining When to Implement Payment Suspensions

Posted by Michael Rosen, ESQ on Thu, Sep 14, 2017

 The Office of Inspector General (OIG) for Health and Human Services (HHS) was given several new powers under the Affordable Care Act (ACA) that added to their hammer of enforcement. According to the HHS OIG, State Medicaid agencies are required to suspend payments for healthcare items and services when there is a “credible allegation of fraud” against the provider, unless “good cause” exists not to suspend payment.  

Using payment suspensions, when appropriate, is important to protect Medicaid funds: payment suspensions based on credible allegations of fraud can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout a law enforcement investigation and potential prosecution of a healthcare fraud case.

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OIG, OIG Work Plan, compliance program

August OIG Work Plan Updates

Posted by Michael Rosen, ESQ on Thu, Aug 24, 2017

Each month, we will be sharing the most recent additions to the Office of Inspector General (OIG) Work Plan items. As of June 2017, OIG updates their Work Plan monthly with any new changes to the active list. Let’s take a look at the new points of emphasis for compliance professionals moving forward.

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Industry News, Healthcare Compliance, OIG

Lessons Learned from OIG Semiannual Report to Congress

Posted by Michael Rosen, ESQ on Tue, Aug 15, 2017

Each year, the Department of Health and Human Services and OIG is tasked with updating Congress on its performance, trends, and actions taken to combat healthcare fraud and abuse.  The mid-term report was issued for the period of October 2016 to March 2017 and describes OIG’s work on identifying significant problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs and operations that were disclosed during the reporting period.

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